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Miliary tuberculomas of the brain: case report
Ahmed Alkhani1, Faisal Al-Otaibi, Edward J Cupler
1Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, MBC-76, P.O. Box 3354, Riyadh 11211, Saudi Arabia. alkhani@kfshrc.edu.sa
Clinical Neurology and Neurosurgery
|April 29, 2006
Summary
Miliary brain tuberculomas, a rare form of central nervous system tuberculosis, can affect immunocompetent individuals. This case highlights their unique presentation and successful treatment with anti-tuberculous therapy.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Central nervous system (CNS) tuberculosis (TB) remains a significant health concern, particularly in developing nations.
- Tuberculomas are frequently considered in the differential diagnosis of intra-axial brain lesions exhibiting contrast enhancement.
- Disseminated or miliary brain tuberculomas represent an exceptionally rare clinical and radiological manifestation of CNS TB.
Observation:
- A case of a 25-year-old immunocompetent female presenting with miliary brain tuberculomas is described.
- The patient exhibited progressive headache and an unsteady gait.
- Serial Magnetic Resonance Imaging (MRI) revealed multiple, small (approx. 2mm) enhancing lesions throughout the brain, with no evidence of systemic TB.
Findings:
- Open brain biopsy confirmed multiple caseating granulomas.
- Mycobacterium tuberculosis was successfully cultured from the biopsy.
- The patient demonstrated significant clinical and radiological improvement following anti-tuberculous pharmacotherapy.
Implications:
- Miliary brain tuberculomas are a rare and distinct entity within CNS tuberculosis.
- This condition can occur in immunocompetent individuals without signs of disseminated disease.
- Early diagnosis and appropriate anti-tuberculous treatment are crucial for favorable outcomes.
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